The Trainer's Take

The 2012-13 NBA campaign seemed like the longest season of Gary Vitti’s 30 as the team’s head athletic trainer … at least until 2013-14.

After the team lost 186 games to injury in 2012-13, Kobe Bryant alone missed all but six of the 82 in 2013-14, and Steve Nash all but 15, as the starting backcourt wasn’t on the floor for 143 of the 319 Lakers games lost to injury. As Vitti explains in an extended Q&A, some of those games missed may have been due to an increasingly fast style of play across the NBA, mixed with increasingly athletic and explosive players putting their bodies at greater risk than at any point in the league’s history.

Vitti also touched on his relationship with good friend/former player he trained/new head coach Byron Scott, his expectations for the health of Bryant (good!) and Nash (we’ll see…) heading into 2014-15 and more.

Below is a transcription of the conversation:

Mike Trudell: I know you have a very strong personal relationship with new head coach Byron Scott, whose second year as a player for the Lakers happened to be your first as the team’s athletic trainer (1984-85). What were your thoughts when he got the job?
Vitti: On a personal note, I was so happy for him, and for myself and the Lakers. Byron and I have a very close personal relationship that was bonded my first year in the NBA. Byron came to the Lakers prior to the 1983-84 season in the trade for Norm Nixon, who was a favorite of the team and the fans. So Byron wasn’t completely welcomed at first because everybody loved Norm. Byron had to break that ice a little bit, and that first year, I think, was hard on him. His second year, I come in, and he doesn't have a lot of bonded friendships with his teammates because he was the new guy, and I didn't know anybody, so we bonded immediately due in some part to his work ethic. He came early, stayed late, would work with me and in the weight room during a time when not many players were lifting. I had to convince players to do it, but Byron was an easy sell because he wanted to be big and strong defensively and still maintain his shooting touch. We really bonded professionally and personally. Of course, the relationship between the head trainer and the player is very different from the relationship between the head coach and the trainer.

MT: What kind of effect, if any, do you anticipate the coming change in your professional relationship might have on your dynamic with Byron?
Vitti: I don't think it will affect us. I think the trust will be fine. Byron and I were cut from the same bolt of cloth. We both have rings with Pat Riley. There's no doubt in my mind Byron will be fine and handle things well. What I don't know is, after a loss does he want to be left alone? Does he want to talk? Does he want input? I'll just follow his lead, because I haven’t seen him in that position for myself. He said a very interesting thing during his press conference, about how a team acts after a loss. When we got on the bus after a loss in the Showtime days, there were no cell phones, you just sat on the bus and you were quiet. Basically, you were quiet until you won your next game. Losses hurt. Of course we're in a new era today, with headphones and all of that. But ultimately, it's Byron's show, and I'm just here to help in any possible way I can.

MT: How would you describe Byron and what he might bring to this job?
Vitti: I think Byron will be tough, but fair, and that's all you can ask of anyone in professional sports. As great of a player as Byron was, he was surrounded by superstars. He understood what it was to not be the man, but to be the part of a team. He was often the fourth option after Magic (Johnson), Kareem (Abdul-Jabbar) and James (Worthy), so he understood that for him to get a shot, it had to come from someone else. I think that's how he wants to impart the game on his players, because that's how he learned it. Now, if Byron has a player that can break somebody down, he’ll allow that. If there’s a drive and kick situation, he’ll allow that player to do that. But I think ball movement is the way he’ll encourage the players to play offensively. Defensively, the first thing in a point guard dominated league will be to stop dribble penetration, then to keep the opposing shooters off their sweet spots. They can shoot the ball, just not where they want to. And third will be to rebound. It sounds simple, but those were the basic tenets of offense and defense when Byron and I grew up in the league.

MT: All right, to focus on your office … The last two years have been especially difficult with injuries, and this after four consecutive seasons of very limited games missed for your players. Where’s your mindset at with how things were so difficult from 2012-14?
Vitti: I pray that it’s behind us. (Laughs) The only games we really had missed for our nine rotation players before that were due to Steve Blake having the chicken pox. Everybody else played 82. So what do you do with the last two seasons? You examine everything that you're doing, which we've always done. The way we run our training room is we evaluate, and we re-evaluate all of our players on a daily basis. Our training programs on a daily basis always start with corrective exercises. From there we go into conditioning, and from there into performance (full-tilt activity). We've analyzed and re-analyzed everything we've done from our standpoint and also look at what’s happening on the basketball court.

The one thing that is changing in the NBA, drastically in the last three years, is that it's become a point guard dominated league where these players are really flying up and down the floor. The speed and power of the game has really changed. Players are moving at the precipice of being in control, and one false move away from being out of control. In short, the slowing-down movement when a defender gets in a player’s way creates a specific type of loading action on soft tissue and joints – an eccentric load – where muscles are actually lengthening instead of shortening. In other words, at the moment before the player makes a cut, he is slowing down, creating that eccentric load. We know that is very hard on joints and the tissue that holds joints together. The other thing that happens when you make those moves is torque on joints, and that's when bad things happen. So you can make that move 100 times, but that 101st time if you're a little off or fatigued, bad things can happen.

MT: And how do you try and counter this type of activity, which as you mentioned, has only been increasing in NBA athletes?

Vitti: Some joints need to be mobile and some need to be stable. The foot needs to have mobility. If it's rigid, it has issues. On the other hand, the knee joint needs to be stable. We don't want a lot of movement at the knee joint. So if we have a foot that's not mobile, we have to mobilize it, put our hands on that person’s foot and get it moving. If we have a knee joint that's too mobile, we have to stabilize it. And so on up the body. We need to identify these different joints and act accordingly. The musculature when we do redundant movement over and over again, we know that we create compensation, and compensation creates dysfunction. For instance, all of this athleticism is coming from their hips. We know that the more athletic players are often tighter in their hip flexors, which reduces the neural drive in the glutes, which is really important for the hip extension. If that’s not working, the hamstring is taking over and doing more than it should. So we need to identify that, at which point we can release the hip flexors. We want to get the player back in alignment and reset the muscles so that they are firing in the pattern in which they’re supposed to. We want to recruit more muscle fibers in the contraction.

MT: As you know, I had a spinal fusion surgery in my lower back in some part because I didn’t have this information while playing a sport in college. I’m guessing young athletes in middle and high school – let alone professionals, where they have trainers like you – could benefit from better understanding this information.
Vitti: Absolutely. We grew up playing three sports, like football, baseball and basketball, and by the simple nature of cross training with different muscles, that prevented redundant training, repeating the same actions over and over again. That repetitive motion is going to cause compensation plus dysfunction in young athletes, and we’re seeing more and more problems as a result. That's why you don't want to train someone into fatigue to the point where their default position becomes learned by the body.

MT: You mentioned how a player can make a move 100 times, and on the 101st, bad things happen. One could think of Derrick Rose when he tore his ACL on an explosive drive to the hoop, or, more close to home, Kobe Bryant tearing his Achilles on a simple move to his left.
Vitti: In Kobe’s case, a lot of people said it was the 47 minutes per game. That’s tough to argue with. Let’s go further. Why did it have to be that game, or the game before, or the game after? Let's use the word attrition. Why was it that period of time? What about the entire season, or the season before?

MT: Or the three straight trips to the Finals plus the Olympics…
Vitti: Maybe it's the attrition of his whole life playing basketball*, and maybe on that particular day, with that particular move, the attrition of all those things came together. Or maybe it's the speed of the game? Maybe it’s the dysfunction over time that is impossible to undo. Kobe has played 54,208 combined regular season and playoff minutes, more than all but four players in the entire history of the NBA (Kareem Abdul-Jabbar, Karl Malone, Jason Kidd and Wilt Chamberlain).

Let's go back to Jordan Farmar. He hurts his hamstring, we keep him out for a month. He comes back and almost immediately hurts the same hamstring in a different place. The tear was healed as we saw under ultrasound, but a new one popped up. So those loads go somewhere because of that dysfunction, and you can only correct it to a point. As much science is there, it’s an inexact science. And then we have attrition, and then we have bad luck. Is it one of those things, a combination of all those things for either Kobe or Jordan? We all want to know that. If we could find that out, we could make sure it wouldn’t happen again.

MT: And nobody ever gets injured. Sign me up!
Vitti: That's the frustrating part of it. Not only do we take great pains to do everything possible to prevent another injury, but we look at the schedule. If it’s a point guard, do we want to bring him back against Tony Parker? Do we want to buy him another four days if we keep him out one more game, depending on the time of the year? It’s all taken under consideration.

MT: Getting back to Kobe … so there are two ways of looking at his health heading into this season. One, he’s only played six games since April of 2013, and has thus finally had a chance to both rest and train his body for a truly extended period of time for the first time in his career. Two, he’s played only six games, aged that much more, and his body could be more susceptible to getting re-injured since he’s been out of true NBA game shape for so long. You’ve been with Kobe for literally his entire career. How do you look at his situation heading into the coming season?
Vitti: This is a debate case where you can make a case on either side. One of the biggest issues we have in the NBA is lack of recovery time. So Kobe has had plenty of time to recover. The second part of that: there is a certain edge that you have to continue your training with the appropriate amount of recovery time that, I won’t say you can lose it, but you have to pay more attention to getting it back. Because there’s nothing you can do to recreate playing in an NBA game other than playing in an NBA game. No matter how hard you would train, even in full 5-on-5 preseason games, it's still not the same as a real NBA game from game one to game 82 and into the playoffs. So you haven't done anything to compete at that level. But … we're also talking about Kobe Bryant. And he will figure it out. He’ll just figure it out.

MT: Kobe is of course coming off the left Achilles tear on April 12, 2013, and the small knee fracture on Dec. 17, 2013, both of which have completely healed. Bryant said at his camp in Santa Barbara that he’s fully healthy and weighs 215 pounds, his typical playing weight in January. It’s pretty tough, for me at least having been around him since 2008, to bet against him.
Vitti: You’d be crazy to bet against him.

MT: With that said, there is the fair counter argument centered on his age (Bryant turns 36 on August 23) and attrition on top of the recent injuries. What else does he do to make sure he can stay healthy?
Bryant: He's gone to the next level of nutrition. In fact, he has somebody come and picks his meals up here at the practice facility. Our chef makes his meals daily. He’s also done a lot of functional movement assessment over this past year that he’s been out, identifying how the way he's played over all these years had created some dysfunction. When you’re young, you can get away with that, but it catches up as you get older and he’s paying more attention corrective exercise prior to performance. Kobe is doing everything right.

You said something about not wanting to bet against him, but I would like you to do that, publicly. Not that he needs any more motivation. Kobe Bryant is a brilliant basketball player. Kobe Bryant is a great athlete, but there were actually players that were more athletic than Kobe. So why him? It's in his mind and his heart and soul. He just has something about him that most people don't. No matter what you think of Kobe Bryant, he's extremely athletic, extremely talented, works harder than anyone else, is tough as nails and intellectually brilliant. You can't take those five things away from him. When you put them all together, you end up with a very, very successful person. Now, it comes with ‘stuff,’ and he'll be the first one to admit it, but wouldn't you rather have a guy that has those five things and deal with the ‘stuff’ than have a guy that doesn't have any ‘stuff’ but you’re trying to instill one of those five things in him. I'll take the dude with the five things.

MT: How possible is it that Bryant will keep his body healthy for the 2014-15 season?
Vitti: I have 100 percent confidence that he'll be healthy because of the way he handles his body and the style of play that we'll compete at. We can't play at a frenetic pace. We can push the ball when it's there, and we can certainly let Kobe create out of the post with his back to the basket at this stage of his career…

MT: Well, you can make a pretty good argument that he’s among the best, if not the best, low-post players in the NBA today.
Vitti: Absolutely. I think he is. And I think we’ll play a style of basketball that is conducive to what Kobe’s body will allow him to do, instead of putting him in situations that aren’t suited for him. I'm not saying that we should play the triangle – Byron is a Princeton guy and there are going to be a conglomeration of a lot of different things – but when we did, we controlled the pace of the game. Therefore, you put a player like Kobe in the best situation to be successful with the least amount of risk. Once you step on the court you're at risk, but the pace of the game makes a difference. If you look at our team as a whole, you have many pace-controlled players that know how to play, as opposed to just running and jumping as high as they can.

MT: That gets back to what you were saying earlier with the pace of the NBA increasing in general in the last three years specifically…
Vitti: It's the NBA that has gone in that direction in the last few years, not a specific coach or group of coaches. If you look at the European players as a whole, they’re really fundamentally sound, not as athletic as the American players, more finesse. You have the South American players who are fundamentally sound like the Euro’s, but more physical. Then you have the Americans, who are extremely athletic and physical, and not as fundamentally sound because they haven’t had to be, especially in the AAU system. That athleticism has translated to the NBA, and that’s what you see. It's not specific to the Lakers. Look at injuries around the league. Look at the major players that have gone out. The stopping on a dime, coupled with the torque … our bodies really weren't meant to do this stuff. The slower you do it, the safer it is.

MT: You obviously have your exceptions to those generalities, like a super physical Euro player in Marc Gasol who’s also fundamentally sound, or a uniquely athletic South American like Manu Ginobili, or a super fundamentally sound American like Kobe, Kevin Durant or Stephen Curry. But you do seem to see fewer major injuries to the fundamentally sound Americans even of the past like Michael Jordan, John Stockton, Magic Johnson, Kevin Garnett, Jason Kidd, Tim Duncan or Kobe before the Achilles.

But part of what you’re saying is that as more and more players get more explosive and put more torque behind moves, the more injuries we’re going to have?

Vitti: The pace and the style was different. Now, at times, we have a track meet with a basketball. And of course, we had plenty of super athletic high flyers in the past, like a Dominique Wilkins. It’s just the simple point from physics: force plus velocity. If I’m in a car and I hit your car while I’m going five miles per hour, it’s not going to do much damage. If I’m going 60 miles per hour, I’m going to do a lot more damage. If I'm driving at five miles an hour and I see your car approaching, it’s going to be easier for me to stop or turn to miss you. But if I’m going 60 miles per hour and I see your car, I’m going to need more space to stop, and it's going to be harder to turn to get out of your way.

MT: That’s a great metaphor. I will use it as my own for years. Anyways … we’ve already touched on this, but what do we do about it?
Vitti: There are basically three postural distortion patterns that we have to correct. So that’s back to corrective exercise. Then it’s back to the conditioning and finally the performance, the acceleration points. You have to train at these speeds so that you can try to keep your body under control at higher speeds. But once again, there’s nothing like playing in an NBA game. So no matter what we do and how much we try to control for these dysfunctions and the speed, there's still the game. Now this has become a part of the game.

MT: Interestingly enough, the two slowest moving players on the roster last season, Robert Sacre and Ryan Kelly, were about the only two that didn’t get hurt. But I digress. One more Kobe question: how many minutes per game should he play next season?
Vitti: I don’t know.

MT: The Spurs had not a single player – even a young guy – play over 30 mintues last year.
Vitti: That's a nice number. There’s a term called the point of diminishing returns, and that’s what we have to figure out. We'll reach a point with Kobe where, if you play him any more than X minutes, is there a diminishing return on that investment. Part two is, well, there are diminishing returns but Kobe is still better than the guy off the bench. Kobe at 60 percent is better than player X on the bench at 100 percent, so you have to fight that urge to keep playing him to an extent because you're increasing his chance of injury. That has to be figured out.

MT: Finally, Gary, what can you expect from Steve Nash this season? He played only 15 games in 2013-14, battling the nerve issues that resulted from his broken leg in the second game of the 2012-13 season.
Vitti: We’re not sure. When nerves are involved, they either get better really quickly, or they take a long, long period of time. There’s usually nothing in between. We're in that really long period now. He'll be coming back to Los Angeles this week, and all my conversations with him are that he has absolutely no neural issue at this point. He's playing full-tilt, unrestricted soccer. He's doing all the corrective injury and performance exercises he's supposed to be doing, and right now he's 100 percent healthy.

Now, how does that translate into putting on an NBA uniform and getting out there with these guys in a point guard dominated league on hardwood, not a grass soccer field. I don't think anybody knows, and nobody wants to know more than Steve. He really wants to play, and he's committed himself to do whatever it is to play. If he can't, we'll have to address that when the time comes.

MT: But things do look better today?
Vitti: Right now things look better on July 31, 2014, than they did July 31, 2013. He was still having nerve issues last July.

MT: There’s a segment of fans who have been very frustrated that Nash hasn’t been able to be productive compared to expectations due to these injuries, with some going as far as to tell him to just retire. He, meanwhile, has done nothing but desperately try to get his body to cooperate. How do you handle that from the training room?
Vitti: I would never tell Steve that he shouldn't play. At some point, you either can or you can't. Part two of that is, right now, whatever his medical issues are, they do not involve activities of daily living. He can pick up his kids, play with his kids and such. We just want to be cognizant that you're towards the end of your career, and we don't want to do anything to jeopardize your long-term health. Somebody like me has to remind somebody like Steve – because of his nature (as a fighter) – to keep that in the back of his mind; I’m not saying he's there yet, but it's something to be cognizant of. At some point, there may be other things to consider. But as of right now, he's a green light. We're moving forward to get ready for the 2014-15 NBA season. If that changes, it'll be due to what is coming, not where we are at this particular moment.